Department of Obstetrics and Gynecology, Virginia Tech Carilion, Carilion Clinic, Roanoke, Virginia.
Fertility and Infertility Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland.
Fertil Steril. 2018 May;109(5):879-887. doi: 10.1016/j.fertnstert.2018.01.029.
To determine if maternal major depression (MD), antidepressant use, or paternal MD are associated with pregnancy outcomes after non-IVF fertility treatments.
Cohort study.
Clinics.
PATIENT(S): Participants in two randomized trials: PPCOS II (clomiphene citrate versus letrozole for polycystic ovary syndrome), and AMIGOS (gonadotropins versus clomiphene citrate versus letrozole for unexplained infertility).
INTERVENTION(S): Female and male partners completed the Patient Health Questionnaire (PHQ-9). Female medication use was collected. PHQ-9 score ≥10 was used to define currently active MD.
MAIN OUTCOME MEASURE(S): Primary outcome: live birth.
pregnancy, first-trimester miscarriage. Poisson regression models were used to determine relative risks after adjusting for age, race, income, months trying to conceive, smoking, and study (PPCOS II versus AMIGOS).
RESULT(S): Data for 1,650 women and 1,608 men were included. Among women not using an antidepressant, the presence of currently active MD was not associated with poorer fertility outcomes (live birth, miscarriage), but rather was associated with a slightly increased likelihood of pregnancy. Maternal antidepressant use (n = 90) was associated with increased risk of miscarriage, and male partners with currently active MD were less likely to achieve conception.
CONCLUSION(S): Currently active MD in the female partner does not negatively affect non-IVF treatment outcomes; however, currently active MD in the male partner may lower the likelihood of pregnancy. Maternal antidepressant use is associated with first-trimester pregnancy loss, which may depend upon the type of antidepressant.
NCT00719186 and NCT01044862.
确定母体重度抑郁症（MD）、抗抑郁药物使用或父体 MD 是否与非 IVF 生育治疗后的妊娠结局相关。
队列研究。
诊所。
参与两项随机试验的患者：PPCOS II（枸橼酸氯米酚与来曲唑治疗多囊卵巢综合征）和 AMIGOS（促性腺激素与枸橼酸氯米酚与来曲唑治疗不明原因不孕）。
女性和男性伴侣完成了患者健康问卷（PHQ-9）。收集女性用药情况。PHQ-9 得分≥10 用于定义当前活跃的 MD。
主要结局：活产。
妊娠，早期流产。使用泊松回归模型调整年龄、种族、收入、尝试受孕月数、吸烟和研究（PPCOS II 与 AMIGOS）后，确定相对风险。
共纳入 1650 名女性和 1608 名男性的数据。在未使用抗抑郁药的女性中，当前活跃的 MD 与较差的生育结局（活产、流产）无关，而是与妊娠的可能性略有增加相关。母亲使用抗抑郁药（n=90）与流产风险增加相关，而当前活跃的男性伴侣则不太可能受孕。
母体当前活跃的 MD 不会对非 IVF 治疗结局产生负面影响；然而，父体当前活跃的 MD 可能会降低妊娠的可能性。母亲使用抗抑郁药与早期妊娠流产相关，这可能取决于抗抑郁药的类型。
NCT00719186 和 NCT01044862。
